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Essential Health Benefits: alancing Affordability and Adequac John Santa MD MPH Director, Health Ratings Center Consumer Reports February 3, 2012
Essential Health Benefits: Balancing Affordability and Adequacy
John Santa MD MPHDirector, Health Ratings CenterConsumer ReportsFebruary 3, 2012
12. Consumer Reports employee
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Systems are perfectly designed to get the results they achieve.
Key Decisions Already Made
• Should health insurance be market based?
• If market based should we enable/encourage competition?
• Should that competition include price/cost?
IOM Essential Health BenefitsPrinciples for Proceeding
• Economics• Ethics• Evidence based practice• Population health
Functional Competition
• Level playing field– What is promised---benefits– What it costs---premium, cost share– What is delivered---access, quality
Benefits
• Adequacy– Precise, understandable benefit language– Clear cut limits and exclusions– Understandable key definitions– Metric that expresses benefit value
• Affordability– Precise, understandable price language– Metric that expresses impact of cost sharing
“When you’re through learning, you’re through.”
John WoodenFormer UCLA basketball coach
